Wiki Preventive service with procedure

[abhishekrane32@yahoo.com]

I am doing EM audit and have a query regarding preventive service.

Patient comes for annual health check up and also complaints having cellulitis on his arm. ROS and PE are comprehensive. chart does not qualify for preventive since risk factor counselling is not documented. I and D is performed for cellulitis how to code the chart.


and in same scenario if chart qualifies for preventive then, do i need to assign 25 modifier to preventive code.

please help

ABHISHEK RANE CPC

 

[OCD_coder]

If the E&M isn't a significant workup from the I&D, then the I&D is the only CPT code you would use.

Yes to the mod-25, all E&M's need a mod-25 when there is a significant or separate service performed with a minor procedure.

 

[valleycoder]

I agree, if preventative elements are not met, you shouldn't bill it. If the procedure wasn't preplanned, you could possibly bill a regular e/m with the procedure BUT it depends of the circumstances surrounding the procedure.

Regarding modifier 25, yes, it would be applied to the E/M code, not the procedure.

Hope that helps.